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Incerti Parenti S, Fiordelli A, Bartolucci ML, Martina S, D'Antò V, Alessandri-Bonetti G. Diagnostic accuracy of screening questionnaires for obstructive sleep apnea in children: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101464. [PMID: 33827032 DOI: 10.1016/j.smrv.2021.101464] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/24/2020] [Accepted: 02/12/2021] [Indexed: 02/06/2023]
Abstract
This systematic review and meta-analysis evaluated the diagnostic accuracy of screening questionnaires for pediatric obstructive sleep apnea (OSA). Studies comparing any questionnaire with polysomnography for OSA detection in subjects aged ≤18 y were considered eligible for qualitative analysis. The quality assessment of diagnostic accuracy studies (QUADAS-2) tool was used for bias assessment. Only questionnaires adopted by at least four studies using the currently accepted diagnostic threshold of apnea-hypopnea index (AHI) ≥1 were included for further selective quantitative analyses. A bivariate meta-analysis was performed to calculate sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio; summary receiver operator characteristic curves were constructed. 37 studies (20 questionnaires) were eligible for qualitative analysis; none were considered of low quality. Among these articles, 13 studies and two questionnaires (sleep-related breathing disorder scale of the pediatric sleep questionnaire (SRBD-PSQ) and OSA-18) satisfied the criteria for quantitative synthesis. SRBD-PSQ had higher sensitivity (0.76) than OSA-18 (0.56), while OSA-18 exhibited higher specificity (0.73) than SRBD-PSQ (0.43). SRBD-PSQ performed well and was the most sensitive screening questionnaire using the diagnostic threshold of AHI ≥1 for pediatric OSA. However, further well-designed studies are still required to assess the role of SRBD-PSQ in real-world clinical populations.
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Affiliation(s)
- Serena Incerti Parenti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy
| | - Andrea Fiordelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy
| | - Maria L Bartolucci
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
| | - Vincenzo D'Antò
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Giulio Alessandri-Bonetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy.
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Hsieh CW, Chen C, Su HC, Chen KH. Exploring the efficacy of using hypertonic saline for nebulizing treatment in children with bronchiolitis: a meta-analysis of randomized controlled trials. BMC Pediatr 2020; 20:434. [PMID: 32928154 PMCID: PMC7489028 DOI: 10.1186/s12887-020-02314-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Inhaled hypertonic saline (HS) has shown benefit in decreasing airway edema in acute bronchiolitis which is the most common lower respiratory infection resulting in dyspnea among infants under 2 years old. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of HS in the implementation of treatment with nebulized HS among children with bronchiolitis. METHODS A systematic literature search was conducted using Cochrane Library, PubMed, EMBASE and Airiti Library (Chinese Database) for randomized controlled trials from inception to July 2019. We calculated pooled risk ratios (RR), mean difference (MD) and 95% CI using RevMan 5.3 for meta-analysis. RESULTS There were 4186 children from 32 publications included. Compared to the control group, the HS group exhibited significant reduction of severity of respiratory distress, included studies used the Clinical Severity Score (n = 8; MD, - 0.71; 95% CI, - 1.15 to - 0.27; I2 = 73%) and full stop after Respiratory Distress Assessment Instrument (n = 5; MD, - 0.60; 95% CI, - 0.95 to - 0.26; I2 = 0%) for evaluation respectively. Further, the HS group decreased the length of hospital stay 0.54 days (n = 20; MD, - 0.54; 95% CI, - 0.86 to - 0.23; I2 = 81%). CONCLUSIONS We conclude that nebulization with 3% saline solution is effective in decreasing the length of hospital stay and the severity of symptoms as compared with 0.9% saline solution among children with acute bronchiolitis. Further rigorous randomized controlled trials with large sample size are needed.
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Affiliation(s)
- Chia-Wen Hsieh
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116 Taiwan, Republic of China
- Evidence-based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hui-Chuan Su
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kee-Hsin Chen
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Postinfectious Bronchiolitis Obliterans in Children: Diagnostic Workup and Therapeutic Options: A Workshop Report. Can Respir J 2020; 2020:5852827. [PMID: 32076469 PMCID: PMC7013295 DOI: 10.1155/2020/5852827] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 12/23/2022] Open
Abstract
Bronchiolitis obliterans (BO) is a rare, chronic form of obstructive lung disease, often initiated with injury of the bronchiolar epithelium followed by an inflammatory response and progressive fibrosis of small airways resulting in nonuniform luminal obliteration or narrowing. The term BO comprises a group of diseases with different underlying etiologies, courses, and characteristics. Among the better recognized inciting stimuli leading to BO are airway pathogens such as adenovirus and mycoplasma, which, in a small percentage of infected children, will result in progressive fixed airflow obstruction, an entity referred to as postinfectious bronchiolitis obliterans (PIBO). The present knowledge on BO in general is reasonably well developed, in part because of the relatively high incidence in patients who have undergone lung transplantation or bone marrow transplant recipients who have had graft-versus-host disease in the posttransplant period. The cellular and molecular pathways involved in PIBO, while assumed to be similar, have not been adequately elucidated. Since 2016, an international consortium of experts with an interest in PIBO assembles on a regular basis in Geisenheim, Germany, to discuss key areas in PIBO which include diagnostic workup, treatment strategies, and research fields.
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Atag E, Krivec U, Ersu R. Non-invasive Ventilation for Children With Chronic Lung Disease. Front Pediatr 2020; 8:561639. [PMID: 33262959 PMCID: PMC7687222 DOI: 10.3389/fped.2020.561639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
Advances in medical care and supportive care options have contributed to the survival of children with complex disorders, including children with chronic lung disease. By delivering a positive pressure or a volume during the patient's inspiration, NIV is able to reverse nocturnal alveolar hypoventilation in patients who experience hypoventilation during sleep, such as patients with chronic lung disease. Bronchopulmonary dysplasia (BPD) is a common complication of prematurity, and despite significant advances in neonatal care over recent decades its incidence has not diminished. Most affected infants have mild disease and require a short period of oxygen supplementation or respiratory support. However, severely affected infants can become dependent on positive pressure support for a prolonged period. In case of established severe BPD, respiratory support with non-invasive or invasive positive pressure ventilation is required. Patients with cystic fibrosis (CF) and advanced lung disease develop hypoxaemia and hypercapnia during sleep and hypoventilation during sleep usually predates daytime hypercapnia. Hypoxaemia and hypercapnia indicates poor prognosis and prompts referral for lung transplantation. The prevention of respiratory failure during sleep in CF may prolong survival. Long-term oxygen therapy has not been shown to improve survival in people with CF. A Cochrane review on the use NIV in CF concluded that NIV in combination with oxygen therapy improves gas exchange during sleep to a greater extent than oxygen therapy alone in people with moderate to severe CF lung disease. Uncontrolled, non-randomized studies suggest survival benefit with NIV in addition to being an effective bridge to transplantation. Complications of NIV relate mainly to prolonged use of a face or nasal mask which can lead to skin trauma, and neurodevelopmental delay by acting as a physical barrier to social interaction. Another associated risk is pulmonary aspiration caused by vomiting whilst wearing a face mask. Adherence to NIV is one of the major barriers to treatment in children. This article will review the current evidence for indications, adverse effects and long term follow up including adherence to NIV in children with chronic lung disease.
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Affiliation(s)
- Emine Atag
- Division of Pediatric Pulmonology, Medipol University, Istanbul, Turkey
| | - Uros Krivec
- Division of Pediatric Pulmonology, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Refika Ersu
- Division of Pediatric Respirology, Children's Hospital of Ontario, University of Ottawa, Ottawa, ON, Canada
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Lo K, Keung V, Cheung C, Tam W, Lee A. Associations between Sleep Pattern and Quality and Cardiovascular Risk Factors among Macao School Students. Child Obes 2019; 15:387-396. [PMID: 31140858 DOI: 10.1089/chi.2018.0319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Despite accumulating evidence showing that sleep duration and cardiometabolic health are correlated, the association of sleep regularity and quality with cardiovascular risk factors in children and adolescents remains inconclusive. Therefore, we examined the relationship between sleep regularity/quality and cardiovascular risk factors in children and adolescents in Macao, China. Methods: We conducted a cross-sectional study among primary and secondary school students (age range: 9-18 years) in Macao, China. Body weight, height, waist circumference (WC), and serum lipid levels were measured. Sleep regularity and sleep quality were assessed by using the Pittsburgh Sleep Quality Index. Multivariable logistic regression was conducted to examine the relationship of sleep variables with the increased likelihood of body mass index (BMI)-classified overweight/obesity, WC-classified obesity, and dyslipidemia. Results: A total of 1078 school students were included in the analysis. Differences of >2 hours between weekday and weekend bedtimes were associated with the increased risk of BMI-classified overweight/obesity (odds ratio = 2.58, 95% confidence interval = 1.55-4.31, p < 0.01) after being adjusted for sleep variables and lifestyle factors. No statistically significant association was found between poor sleep quality and any other outcome. Conclusions: Irregular bedtime was associated with elevated body weight regardless of sleep amount and quality. Thus, regular bedtimes are recommended as a simple but practical strategy for preventing obesity.
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Affiliation(s)
- Kenneth Lo
- 1Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guang Zhou, China.,2Department of Epidemiology, Center for Global Cardiometabolic Health, Brown University, Providence, RI.,3JC School of Public Health and Primary Care, Faculty of Medicine, Shatin, the Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vera Keung
- 3JC School of Public Health and Primary Care, Faculty of Medicine, Shatin, the Chinese University of Hong Kong, Hong Kong, Hong Kong.,4Center for Health Education and Health Promotion, Shatin, the Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Calvin Cheung
- 3JC School of Public Health and Primary Care, Faculty of Medicine, Shatin, the Chinese University of Hong Kong, Hong Kong, Hong Kong.,4Center for Health Education and Health Promotion, Shatin, the Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Wilson Tam
- 5Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Albert Lee
- 3JC School of Public Health and Primary Care, Faculty of Medicine, Shatin, the Chinese University of Hong Kong, Hong Kong, Hong Kong.,4Center for Health Education and Health Promotion, Shatin, the Chinese University of Hong Kong, Hong Kong, Hong Kong
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Wood ME, Stockwell RE, Johnson GR, Ramsay KA, Sherrard LJ, Jabbour N, Ballard E, O'Rourke P, Kidd TJ, Wainwright CE, Knibbs LD, Sly PD, Morawska L, Bell SC. Face Masks and Cough Etiquette Reduce the Cough Aerosol Concentration of Pseudomonas aeruginosa in People with Cystic Fibrosis. Am J Respir Crit Care Med 2019; 197:348-355. [PMID: 28930641 DOI: 10.1164/rccm.201707-1457oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE People with cystic fibrosis (CF) generate Pseudomonas aeruginosa in droplet nuclei during coughing. The use of surgical masks has been recommended in healthcare settings to minimize pathogen transmission between patients with CF. OBJECTIVES To determine if face masks and cough etiquette reduce viable P. aeruginosa aerosolized during coughing. METHODS Twenty-five adults with CF and chronic P. aeruginosa infection were recruited. Participants performed six talking and coughing maneuvers, with or without face masks (surgical and N95) and hand covering the mouth when coughing (cough etiquette) in an aerosol-sampling device. An Andersen Cascade Impactor was used to sample the aerosol at 2 meters from each participant. Quantitative sputum and aerosol bacterial cultures were performed, and participants rated the mask comfort levels during the cough maneuvers. MEASUREMENTS AND MAIN RESULTS During uncovered coughing (reference maneuver), 19 of 25 (76%) participants produced aerosols containing P. aeruginosa, with a positive correlation found between sputum P. aeruginosa concentration (measured as cfu/ml) and aerosol P. aeruginosa colony-forming units. There was a reduction in aerosol P. aeruginosa load during coughing with a surgical mask, coughing with an N95 mask, and cough etiquette compared with uncovered coughing (P < 0.001). A similar reduction in total colony-forming units was observed for both masks during coughing; yet, participants rated the surgical masks as more comfortable (P = 0.013). Cough etiquette provided approximately half the reduction of viable aerosols of the mask interventions during voluntary coughing. Talking was a low viable aerosol-producing activity. CONCLUSIONS Face masks reduce cough-generated P. aeruginosa aerosols, with the surgical mask providing enhanced comfort. Cough etiquette was less effective at reducing viable aerosols.
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Affiliation(s)
- Michelle E Wood
- 1 Lung Bacteria Group and.,2 Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Australia.,3 Faculty of Medicine and
| | | | - Graham R Johnson
- 4 International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Kay A Ramsay
- 1 Lung Bacteria Group and.,3 Faculty of Medicine and
| | - Laura J Sherrard
- 1 Lung Bacteria Group and.,5 School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom
| | - Nassib Jabbour
- 4 International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Emma Ballard
- 6 Statistical Support Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Peter O'Rourke
- 6 Statistical Support Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Timothy J Kidd
- 1 Lung Bacteria Group and.,7 School of Chemistry and Biomolecular Sciences, The University of Queensland, Brisbane, Australia.,8 Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Claire E Wainwright
- 3 Faculty of Medicine and.,8 Child Health Research Centre, The University of Queensland, South Brisbane, Australia.,9 Lady Cilento Children's Hospital, South Brisbane, Australia; and
| | - Luke D Knibbs
- 10 School of Public Health, The University of Queensland, Herston, Australia
| | - Peter D Sly
- 3 Faculty of Medicine and.,8 Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Lidia Morawska
- 4 International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Scott C Bell
- 1 Lung Bacteria Group and.,2 Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Australia.,3 Faculty of Medicine and
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Abstract
INTRODUCTION Bronchiolitis obliterans (BO) is a chronic and irreversible obstructive lung disease leading to the obstruction and/or obliteration of the small airways. Three main BO entities are distinguished: post-infectious BO (PIBO); BO post lung transplantation; and BO after bone marrow transplantation (BMT) or hematopoietic stem cell transplantation (HSCT). All three entities are separate, however, there are similarities in histopathological characteristics and possibly in aspects of the development pathway. Areas covered: We review current evidence of bronchiolitis obliterans diagnosis and management in children. The diagnosis of BO is usually based on a combination of history, clinical and radiological findings, although lung biopsy and histopathology remain the gold standard approaches to confirm BO. Expert opinion: At present, we do not have a clear understanding of the mechanisms of the development of BO and lack strong evidence for treatment. Although most BO in children is post-infectious, most of the current evidence for treatment originates from studies analyzing BO in adult lung transplant and HSCT patients. BO management requires multidisciplinary approach and care in specialized centers.
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Affiliation(s)
- Ema Kavaliunaite
- a Respiratory Unit , Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Paul Aurora
- a Respiratory Unit , Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK.,b Respiratory Critical Care and Anaesthesia Section , Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health , London , UK
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Michelet D, Julien-Marsollier F, Vacher T, Bellon M, Skhiri A, Bruneau B, Fournier J, Diallo T, Luce V, Brasher C, Dahmani S. Accuracy of the sleep-related breathing disorder scale to diagnose obstructive sleep apnea in children: a meta-analysis. Sleep Med 2019; 54:78-85. [DOI: 10.1016/j.sleep.2018.09.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 12/11/2022]
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Clinical features of postinfectious bronchiolitis obliterans in children undergoing long-term nebulization treatment. World J Pediatr 2018; 14:498-503. [PMID: 30269305 DOI: 10.1007/s12519-018-0193-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Limited data are available in relation to the clinical features of PIBO undergoing prolonged nebulization treatment with budesonide, terbutaline and ipratropium bromide. This retrospective study aimed to outline the features of clinical, high-resolution computed tomography (HRCT) and pulmonary function test (PFT) of PIBO, undergoing maintenance therapy utilizing a triple nebulization treatment and to determine the factors associated with prognosis. METHODS Children diagnosed with PIBO were followed up between April 2014 and March 2017. The clinical features after maintenance nebulization treatment for 12 months were thereafter summarized. RESULTS Thirty patients, 21 boys and 9 girls, were enrolled in the study. The median age of patients was 17.4 months, with a range between 3.0 and 33 months. Persistent coughing and wheezing were detected whilst wheezing and crackles were the common manifestations presented. HRCT scans revealed patchy ground and glass opacity, while PFT showed fixed airway obstruction in all patients. Four patients were lost during follow-up. After treatment, the clinical symptoms were improved greatly in all patients (P < 0.01). The mean increase in the percentage of TPEF%TE and VPEF%VE were improved greatly (P < 0.01). Images of the HRCT scan indicated marked improvements in 18 patients (81.8%) in comparison with scans obtained pre-treatment. CONCLUSIONS Our data suggest a potential role of long-term nebulization treatment of budesonide, terbutaline, ipratropium bromide on PIBO, due to its efficacy as indicated in the improved clinical symptoms, pulmonary functions and CT manifestations identified in the children. New prospective and controlled studies are required to confirm this proposition.
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Restless legs syndrome in children with allergic rhinitis: A comparative study on frequency, severity and sleep quality. Turk J Phys Med Rehabil 2018; 64:198-204. [PMID: 31453512 DOI: 10.5606/tftrd.2018.2265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/11/2018] [Indexed: 12/18/2022] Open
Abstract
Objectives This study aims to investigate the frequency and severity of restless legs syndrome (RLS) and its relationship with sleep quality in children with allergic rhinitis (AR) with the hypothesis that comorbid RLS may be an additional causative factor of sleep disturbances in pediatric AR. Patients and methods A total of 143 children with AR (aged 8-18 years) and 144 healthy control subjects (aged 8-18 years) were included. The diagnosis of AR was established on history, clinical examination and skin prick test according to the Allergic Rhinitis and its Impact on Asthma guidelines. Presence of RLS was determined using the International RLS study group (IRLSSG) criteria. The severity of RLS was assessed using the IRLSSG rating scale. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI). Results Thirteen patients (9.1%) in AR group, and six children (4.2%) in control group had RLS (p=0.159). The frequency of RLS in AR group was higher than two folds when compared to the control group; however, the difference was not statistically significant. Restless legs syndrome severity score was significantly higher in AR group than control group (15.00 [11-20] and 11.00 [10-16] respectively, p=0.046). Total PSQI scores were similar between groups. Also, no significant differences were observed in total PSQI scores of AR patients with or without RLS. Conclusion Restless legs syndrome was not more common but was more severe in children with AR. There was no evidence that RLS has an obvious effect on sleep quality in children with AR.
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Evans S, Djilas V, Seidman LC, Zeltzer LK, Tsao JCI. Sleep Quality, Affect, Pain, and Disability in Children With Chronic Pain: Is Affect a Mediator or Moderator? THE JOURNAL OF PAIN 2017; 18:1087-1095. [PMID: 28479208 DOI: 10.1016/j.jpain.2017.04.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/18/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
Sleep problems have been identified as a potential antecedent of chronic pain and pain-related disability in pediatric populations. In adult studies, affect has been implicated in these relationships. This study sought to better understand the relationships between sleep quality, negative and positive affect, and pain and functioning in children with chronic pain. Participants included 213 children and adolescents (aged 7-17 years) presenting to a tertiary pain clinic with chronic pain. Children completed questionnaires measuring sleep quality, positive and negative affect, pain intensity, and functional disability. Results indicated that 74% of children reported disordered sleeping and that poor sleep quality was significantly associated with increased pain, disability, negative affect, and decreased positive affect. Our hypotheses were partially supported, with negative affect (but not positive affect) mediating the relationship between poor sleep and increased pain; and positive as well as negative affect mediating the relationship between poor sleep and increased functional disability. There was no evidence for affect as a moderator. This study adds to the growing literature demonstrating the effect of poor sleep quality on children's pain and functioning, highlighting the need to develop further longitudinal research to confirm the causal roles of these variables. PERSPECTIVE This article examines the relationship between poor sleep quality, affect (negative as well as positive), pain, and disability in children with chronic pain. The findings have the potential to better understand the processes involved in how poor sleep may lead to increased pain and pain-related disability.
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Affiliation(s)
- Subhadra Evans
- School of Psychology, Deakin University, Geelong, Australia.
| | - Vesna Djilas
- School of Psychology, Deakin University, Geelong, Australia
| | - Laura C Seidman
- UCLA Pediatric Pain and Palliative Care Program, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Lonnie K Zeltzer
- UCLA Pediatric Pain and Palliative Care Program, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Jennie C I Tsao
- UCLA Pediatric Pain and Palliative Care Program, David Geffen School of Medicine at University of California, Los Angeles, California
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Barış HE, Gökdemir Y, Eralp EE, İkizoğlu NB, Karakoç F, Karadağ B, Ersu R. Clinical and polysomnographic features of children evaluated with polysomnography in pediatric sleep laboratory. Turk Arch Pediatr 2017; 52:23-29. [PMID: 28439197 DOI: 10.5152/turkpediatriars.2017.4218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/12/2017] [Indexed: 11/22/2022]
Abstract
AIM Sleep disordered breathing is a common problem in childhood that encompasses a spectrum of disorders extending from primary snoring to obstructive sleep apnea. This study aims to investigate the results of children undergoing evaluation with polysomnography in the sleep laboratory of a tertiary care hospital. MATERIAL AND METHODS Demographic and clinical features as well as sleep associated symptoms, scores of pediatric sleep questionnaire and Pittsburgh sleep quality index and polysomnography results are retrospectively evaluated. RESULTS Totally 131 patients were evaluated, of which 47.3% (n=62) were females and 52.7% (n=69) were males. Mean age was 101.85±59.15 months at the time of the study. Fifty percent (n=59) of patients complained of snoring and 43.7% (n=52) of patients complained of apnea during sleep. Mean obstructive hypopnea-apnea index was 5.12±11.72. Mean obstructive hypopnea-apnea index of snorers (6.93±13.53) was significantly higher than the mean obstructive hypopnea-apnea index of nonsnorers (2.32±5.43) (p=0.011). Mean obstructive hypopnea-apnea index of patients experiencing apnea during sleep (7.52±14.25) was significantly higher than the mean obstructive hypopnea-apnea index of the children who do not experience apnea (2.61±5.84) (p=0.008). No significant correlation was observed between obstructive hypopnea-apnea index and scores of pediatric sleep questionnaire and Pittsburgh sleep quality index. The prevalence of obstructive sleep apnea was 33.6% (n=44). Forty nine patients (39.8%) were treated after polysomnography. Frequently suggested treatment options were noninvasive mechanical ventilation (n=23, 46.9%), intranasal steroid (n=15, 30.6%), montelukast (n=11, 22.4%) and adenotonsillectomy (n=9, 18.4%). CONCLUSIONS Polysomnography is the gold standard in the diagnosis of sleep disordered breathing in children. Pediatricians should be able to recognize early signs and symptoms of sleep disordered breathing and refer the patients in risk to centers where evaluation with polysomnography is available.
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Affiliation(s)
- Hatice Ezgi Barış
- Department of Pediatrics, Marmara University, Pendik Education and Research Hospital, İstanbul, Turkey
| | - Yasemin Gökdemir
- Department of Pediatrics, Division of Pediatric Chest Diseases, Marmara University, Pendik Education and Research Hospital, İstanbul, Turkey
| | - Ela Erdem Eralp
- Department of Pediatrics, Division of Pediatric Chest Diseases, Marmara University, Pendik Education and Research Hospital, İstanbul, Turkey
| | - Nilay Baş İkizoğlu
- Department of Pediatrics, Division of Pediatric Chest Diseases, Marmara University, Pendik Education and Research Hospital, İstanbul, Turkey
| | - Fazilet Karakoç
- Department of Pediatrics, Division of Pediatric Chest Diseases, Marmara University, Pendik Education and Research Hospital, İstanbul, Turkey
| | - Bülent Karadağ
- Department of Pediatrics, Division of Pediatric Chest Diseases, Marmara University, Pendik Education and Research Hospital, İstanbul, Turkey
| | - Refika Ersu
- Department of Pediatrics, Division of Pediatric Chest Diseases, Marmara University, Pendik Education and Research Hospital, İstanbul, Turkey
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